Daughter fights Ottawa Hospital’s plans to discharge ailing mother

Maria Cook, Ottawa Citizen01.02.2013

Barbara Korwin with her mother, Marie, at the Ottawa Hospital. Barbara is fighting the hospital’s decision to discharge Marie into a retirement home or a retirement home. Marie, 89, is bedridden and has advanced dementia.

OTTAWA — When Barbara Korwin was summoned to the Ottawa Hospital for a meeting about her 89-year-old mother, she was given two options: put her in a retirement home or take the first available nursing-home bed.

Korwin, a high-school teacher, refused both. “I think it’s wrong of the hospital to be doing this,” she said. “To put an extremely frail senior in a place where their needs cannot be met, this is a very subtle form of euthanasia.”

She is at loggerheads with the hospital over a new practice: Patients waiting for long-term care — such as her mother — are being sent home or to a seniors’ residence to wait. The goal is to free up costly hospital beds for acutely-ill patients.

Marie Korwin, a widow and former federal public servant, has advanced dementia and is bed-ridden. She needs to be fed, toiletted, bathed and lifted.

Her family’s predicament is not unusual, said Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly. She has handled 250 complaints about hospital discharge in the past year from across Ontario.

“The pressure on the families is absolutely incredible,” she said. “The problem here isn’t seniors holding up beds. The problem is that the system hasn’t been managed properly and there’s not enough long-term-care homes.”

Korwin said her mother is too sick for a retirement home. She doesn’t want the first available nursing home bed, either. Her mother has been on a waiting list since last spring for five preferred long-term care homes.

It is her legal right to go to a nursing home of her choice, said Meadus. “There is never a situation when you have to take a bed you haven’t chosen. The legislation is very clear. Hospitals don’t get to choose which home the person goes to.”

Homes with short waiting lists or readily available beds tend to be less desirable, she adds.

Korwin’s meeting at the hospital took place Dec. 19. Mike Tierney, vice-president of clinical programs for the Ottawa Hospital, can’t speak about specific cases but denied that families are pressured.

“We try to present the options,” he said. “We clearly state that our mandate is for acute care. When your acute care is done, we will try to transition you safely, efficiently and effectively to your next destination.”

The hospital is following a Home First policy, created by the Ontario Ministry of Health and the province’s local health integration networks. It tries to address one of the main issues affecting the health care system: the number of patients who remain in hospital because they are waiting for another level of care. Other Ottawa hospitals are also implementing the approach.

Tierney notes that patients who go home or to a retirement home can receive help from the Champlain Community Care Access Centre (CCAC). The provincial agency provides up to 24 hours a day of nursing, therapy and personal support for two months after discharge. The CCAC participates in discharge decisions.

“We fully embrace the Home First philosophy,” said Tierney. “We have far fewer patients waiting in hospital for long-term care. More of those patients are waiting in other settings, including home, but with the support they need from the CCAC.”

There are about 100 alternate-level-of-care patients at the Ottawa Hospital, some waiting up to two years. It’s down from 160 last January, but the hospital still has bed shortages. “We’ve got 15 patients in the emergency department waiting for an in-patient bed that we aren’t able to assign,” Tierney said before Christmas.

Some people prefer to wait elsewhere, he adds. “The hospital can be a disruptive environment.”

Marie Korwin lived in her own house until she fell and broke her pelvis in November 2010. “It has been a roller coaster since then,” said Korwin, her only child.

In April 2011, she moved into a retirement home. As her health declined and her needs grew, the cost went from $2,500 a month to more than $3,000 a month.

Her monthly income is $2,400 and she was dipping into savings. In spring 2012, the CCAC approved her application for long-term care.

Last September while the elder Korwin was still in the retirement home, she was taken twice to the General campus of the Ottawa hospital in a state of severe dehydration. She remained in hospital after the second episode. “She was at death’s door,” said Korwin.

In October, after she was treated, the hospital began trying to shift her, proposing a retirement home that cost more than $5,000 a month. Korwin refused.

At the Dec. 19 meeting, the hospital social worker suggested two retirement homes that were willing to take her mother for $2,800 a month, although their regular rate is $6,000.

Meadus said that while some people can manage in a retirement home, for others it’s unsafe.

“It’s not an alternative to long-term care and it is not part of our health care system,” she said. “To be pushed into a retirement home means that you’re being asked to pay for something that is less regulated. There’s no guarantee of any kind of minimum staffing, or minimum care standards. They may not have nurses.”

Three women died between 2008 and 2010 in Ottawa retirement homes under a now-defunct program whereby the homes received government funding to provide nursing home-level care. It was touted as a temporary solution to persistent hospital overcrowding, long delays in emergency rooms and long waits for nursing home beds.

The family of one of them, Adele Ironmonger, is suing Valley Stream Manor and the Champlain Local Health Integration Network. She died in 2010 of severe dehydration after three weeks at the facility.

If someone insists on waiting in hospital, “we’ll continue to care for them,” said Tierney. “It’s not our preference because we don’t think it’s the best use of our acute care resources.”

To reduce her mother’s wait for a nursing home bed, Korwin has switched one of her preferred homes to a home with a shorter wait list. She is also willing to accept a shared room rather than hold out for a private room.

Korwin said she wanted to go public for the sake of families in similar situations. “These seniors are not bed blockers. These are people who have contributed to our country and they deserve to spend their final days getting appropriate care.”

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